Bug of the Month - Measles
Measles (Rubeola) is an extremely contagious diseases. In spite of available vaccination programs, measles is reemerging in the United States. In fact, there have been almost 20 outbreaks in the United States in recent years. As of last year, 198 cases of measles were brought in by international travelers and two of these cases occurred right here in Maricopa County. The measles revival is a result of high transmissibility of the measles virus, increasing rates of vaccine refusal and globalization and international travel.
Measles is spread through contact with fluids from an infected person's nose and mouth, either directly or through aerosol transmission, and is highly contagious—90 percent of people without immunity sharing space with an infected person will catch it. An asymptomatic incubation period occurs nine to twelve days from initial exposure and infectivity lasts from two to four days prior, until two to five days following the onset of the rash (i.e. four to nine days infectivity in total).
Clinical diagnosis of measles requires a history of fever of at least three days, with at least one of the three C's (cough, coryza, conjunctivitis). Observation of Koplik's spots (white patches in mouth) is also diagnostic of measles.
Symptoms usually begin eight to 12 days after exposure to the virus. Symptoms may include:
- Bloodshot eyes
- Light sensitivity (photophobia)
- Muscle pain
- Redness and irritation of the eyes (conjunctivitis)
- Runny nose
- Sore throat
- Tiny white spots inside the mouth (Koplik's spots)
- Rash - usually appears three to five days after the first signs of being sick, may last four to seven days, usually starts on the head and spreads to other areas, moving down the body. Rash may appear as flat, discolored areas (macules) and solid, red, raised areas (papules) that later join together
Patients presenting with clinical syndromes where measles is suspected must be placed in Airborne Precautions immediately. Patients presenting in the ED with “cold symptoms” should be masked if they remain in the waiting room for any length of time.